Reactions 1409 - 7 Jul 2012

O SVerapamil/trandolapril overdose

Bradycardia, hypotension and atrioventricularblock: case report

A 17-year-old girl developed bradycardia, hypotensionand atrioventricular (AV) block following poisoning withverapamil/trandolapril [Tarka forte; time to reaction onsetnot clearly stated].

The girl, who had a history of psychological problems,was referred with drug poisoning, syncope and clouding ofconsciousness after ingesting 13 tablets of verapamil240mg/trandolapril 4mg in a suicide attempt. The tabletshad been used by her father to treat hypertension. She hadreceived gastric lavage with activated charcoal at an outsidemedical centre, prior to being transferred to an emergencyservice approximately 7 hours after ingestion. Onexamination, she was lethargic, bradycardic andhypotensive. A second gastric lavage was performed. AnECG revealed complete AV block and laboratory analysisshowed a creatinine level of 1.92 mg/dL.

The girl was managed with sodium chloride, calciumgluconate and dopamine. A temporary pacemaker wasinserted due to persistent AV block and she washospitalised. She regained sinus rhythm and the pacemakerwas removed after approximately 10 hours. She receivedfurther sodium chloride solution and glucose, and wasdischarged on day 3 after making a full recovery.

Author comment: Sinus bradycardia, severe hypotensionand AV blocks can be seen due to excessive use of combinedACE inhibitors and calcium channel blockers.Karadas S, et al. Fixed dose combined antihypertensive agents poisoning: Casereport. Akademik Acil Tip Olgu Sunumlari Dergisi 2: 48-50, No. 2, 2011.Available from: URL: http://dx.doi.org/10.5505/jaemcr.2011.62681 [Turkish;summarised from a translation] - Turkey 803072804

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Reactions 7 Jul 2012 No. 14090114-9954/10/1409-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved